The War on Grief

The DSM-5, the most recent version of psychiatry’s diagnostic bible, makes it possible to classify grieving that endures beyond a rather brief span of time as a mental illness.

This pathologizing of grief has ancient roots extending back at least as far as the Stoics, whose stern ascetic morality preached a perfect indifference that eschewed all passionate attachments. The ideal of selfless asceticism was carried forth in early Christianity, showing up dramatically, for example, in the Confessions of the prominent 12th century monk, Saint Bernard, who was wracked with guilt over his grief for his beloved dead brother. His brother, after all, was enjoying eternal happiness in heaven, so Bernard could only feel his grieving his loss as a manifestation of a wicked selfishness on his own part.

The pathologizing of grief was continued by the philosopher Rene Descartes, usually considered to be the initiator of the Enlightenment and Modernity. In letters to Princess Elizabeth of Bohemia and Constantijn Huygens, he warned that sadness and grief could cause serious physical illnesses, and he recommended a form of mental discipline—reminiscent of both the Stoics and contemporary cognitive-behavior therapies—in which the imagination was to be directed away from the sources of emotional pain and toward objects that could furnish contentment and joy.

Robert D. Stolorow, Ph.D., Ph.D. is a Founding Faculty Member at the Institute of Contemporary Psychoanalysis, Los Angeles, and at the Institute for the Psychoanalytic Study of Subjectivity, New York City. He is the author of World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (Routledge, 2011) and Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (Routledge, 2007) and coauthor of eight other books. He received his Ph.D. in Clinical Psychology from Harvard University in 1970 and his Ph.D. in Philosophy from the University of California at Riverside in 2007.

3 Comments Already

Yes, this paper makes an important point. Furthermore, not just psychiatry, but our whole society makes war not only on grief, but on all emotions.
The idea of negative emotions is an example. Actually emotions are like breathing, there is trouble only if they are interrupted. A “good cry” is far from being painful, it is a pleasure. But one’s family and friends usually don’t allow it, even for children. Most people are allowed too little time for mourning. They are told to “get over it, get a grip,” etc.

“….Cymbalta, which is prescribed for major depressive disorder and generalized anxiety disorder, earned its blockbuster title almost five times over in 2012, bringing in nearly $5 billion to developer Eli Lilly. Lilly’s patent on Cymbalta expired in December 2013, and the developer should soon begin to lose revenue to generics.

But thanks to the changes made by the APA to the DSM, the money will likely keep rolling in.

In past editions of the DSM, a so-called bereavement exclusion from major depressive disorder recommended that actively grieving individuals not be diagnosed with depression. In the DSM-5, this recommendation has been erased, giving rise to “bereavement-related depression” – a subset of major depressive disorder that is treatable by all the standard methods (and drugs) that ease depression. But if you didn’t need to treat the loss of a loved one with medication in 2000, is it really necessary in 2014?

Companies like Lilly certainly want it to be – and they may just get their way. Public records regarding clinical investigations show that Lilly’s expired patent on Cymbalta will in all likelihood be renewed, as it is currently the focus of a new trial for the pharmacological treatment of bereavement-related depression. In other words, it’s going to end up being the drug of choice for treating what was merely called “grief” at the time of Lilly’s original patent filing…..”